If India is to abide by the Millennium Development Goal of eliminating TB by 2050, it needs to radically step up its efforts. India can and should also initiate regional cooperation within the Brics coalition to eradicate this epidemic
Nearly 3.5 lakh Indians die of tuberculosis every year. The disease continues to be a critical public health challenge for the country. India bears the highest TB burden in the world, accounting for one-fourth of the global incidence. 70 per cent of TB patients are in the productive age group of 15 to 44 years. It severely jeopardises human resource development and working capacities of the affected individuals. The economic impact of the disease is in the region of $24 billion annually. TB disproportionately affects the poor and the marginalised; the disease often incapacitates families, leaving a devastating trail in its wake. The costs associated with the diagnosis and treatment of TB push families into vicious debt traps, perpetuating a cycle of poverty for many.
TB is often associated with deep-seated stigma, which not only leads to discrimination within the workplace as well as the community but also ostracism. There exist several issues such as migration, urbanisation, poverty and malnutrition, that continue to remain critical obstacles to effective TB prevention and control.
The Revised National TB Control Programme and its Directly Observed Treatment Short-Course (Dots) project initiated by the Government in 2006 have been acclaimed internationally. Since its inception, nearly 1.75 crore patients have been treated, thus saving more than 30 lakh additional lives. In 2012, the Union Government made TB a notifiable disease and banned the use of outmoded serology tests which have for years led to inaccurate diagnosis. But the disease continues to affect a significant portion of the population, particularly in urban settlements. It is a well-documented fact that cosmopolitan cities like Mumbai, Delhi and Kolkata are dominated by slum clusters which are breeding grounds for infection. Since TB is an airborne disease, such proximal spaces lead to increased TB infection and transmission. On an average, an untreated/undiagnosed TB patient can further infect up to two dozen other people in a year.
The emergence of drug-resistant strains of TB has further complicated the Indian TB scenario. The problem has increased manifold and so have the complications associated with it. India has nearly 1,10,000 cases of multi-drug resistant TB (MDR-TB), a disease type which doesn't respond to the normal treatment regimen. Not only is it difficult to treat, but its treatment is a hundred times more expensive than that of regular TB. A comparable economy like South Africa has only 14,161 MDR-TB patients. There is an increased need to develop a strategic vision coupled with strong commitment for enhanced TB control in India.
It is essential to involve and engage critical stakeholders including the government, civil society and technical experts across the TB landscape in the decision making process. Another aspect which also requires immediate attention is the need to accelerate our efforts towards enhanced research and development, promotion of awareness and capacity building. We need to allocate optimum resources and funds to catalyse indigenous solutions to tackle TB effectively. Sensitising policymakers, politicians and programme implementers at multiple levels is the need of the hour.
It was in response to the urgent need to tackle TB worldwide that a Global TB Summit was organized in Barcelona on October 27, 2014. Parliamentarians from seven different countries attended this summit. The objective of this summit was to galvanise political will to tackle TB, and to create a clear vision for the role of policymakers in combating the disease.
The Global TB Summit showed us that we also need to encapsulate and learn from the International community. Brazil recognised TB as a critical public challenge a decade ago. Key initiatives were introduced by the government to provide access to timely diagnosis and successful treatment, available exclusively through the public sector in Brazil. Funding for TB was increased from five million US dollars in 2002 to $70 million in 2013. Today, the entire TB programme is domestically financed. Multiple primary health care centres were established, which administer the Directly Observed Treatment Short Course.
Similarly, Cambodia too witnessed a drastic increase in TB cases in the 1990s. However, by 2000, it started engaging with other sectors for TB prevention and control. By 2005, a public-private mix strategy was developed. The Dots-based TB centres were increased from 60 in 2000 to 1,200 in 2005, besides 300 per cent rise in the health workers. From 2006 to 2010, the public-private mix strategy was scaled up in 11 provinces and 42 operational districts, reducing the TB burden by almost 45 per cent and surpassing a global TB target of 70 per cent detection and 85 per cent treatment rate.
China has also achieved significant progress over the last 20 years by halving the prevalence of the most infectious form of TB and reducing mortality by 80 per cent. China has expanded the health insurance coverage to make sure that all patients and families including the poorest have access to clinical and MDR-TB.
The Indian Government offers services including diagnosis and treatment, free of cost in the public sector. But more than half of all TB patients continue to access the unregulated private sector for TB detection and treatment, leading to unscientific and incorrect diagnosis coupled with expensive over-the-counter treatment. We must ensure that the private sector is regulated and the national programme initiates measures to engage with the private sector successfully.
A pilot project has been launched recently by the government in collaboration with the private sector in Bihar. The initial outcome appears promising, and it is hoped that with some more coordination and streamlining of processes, an appropriate model could be evolved for replicating in the rest of the country. Globally, new cases of TB have been falling at the rate of 2.2 per cent between 2010 and 2011, and the world is on its way to achieve the global target of 50 per cent reduction in mortality rate by 2015. If India is to abide by the Millennium Development Goal of eliminating TB by 2050, it needs to radically step up its efforts. India can and should also initiate regional cooperation within the Brics coalition to eradicate this epidemic.
(The writer is president of the National Forum on Tuberculosis)